The cost of waiting analytical lens: A gender-responsive policy evaluation tool for wait times

Purpose

Public systems routinely ask, “How long is the wait?” This tool asks, “What happens to people while they are forced to wait—and who absorbs the resulting harm, work and cost?”

The Cost of Waiting Analytical Lens (CWAL) is designed to help policy analysts, governments, researchers, advocates and community organizations identify consequences that conventional wait-time reporting can miss—especially when a service is delayed, unavailable or inaccessible. It supplements existing evaluation by exposing gendered and intersecting inequities, incorporating the knowledge of people seeking services and caregivers, strengthening public accountability, and supporting policy and systems reform.

The tool supports both evaluation and advocacy. Analysts can use it to test whether a program achieves its intended outcome and prevents harm; advocates can use it to show why meeting an administrative target may still leave serious needs unmet; and service organizations can use it to identify gaps and improve delivery.

Introduction

Canadian governments routinely report wait times, processing times, backlogs, service standards and service statistics. These measures are important, but they describe system activity more readily than the experience of people trying to obtain a service. They seldom record lost wages, missed work or education, additional caregiving, time spent in unsafe housing, deteriorating health, the stress of navigating administrative systems or exposure to violence while waiting.

Waiting does not affect everyone in the same way. Women provide most paid and unpaid care, which can undermine their well-being and constrain their choices when public services are delayed or unavailable. Disability, poverty, race, Indigeneity, immigration and family status, gender identity and geography also shape who can absorb the financial, practical and emotional costs of delay (Wray et al., 2023; Wray, 2024).

This report introduces the Cost of Waiting Analytical Lens (CWAL), a gender-responsive measurement framework and four-stage evaluation process. CWAL complements established performance measurement by identifying six dimensions of waiting impacts: economic security, employment and education, unpaid care work, housing stability, safety, and health and well-being; and by asking four questions:

1.   What is the waiting context?

2.   What harms, stresses, work and costs result while people wait?

3.   How are those costs distributed across genders and social groups?

4.   What do current performance-measurement and evaluation approaches fail to see?

The report illustrates the value of CWAL, based on the example of the shelter-to-housing pathway for survivors of gender-based violence. A 2024 survey of women’s shelters found that 94 per cent of emergency shelters are reporting longer stays, 86 per cent said the housing crisis was causing survivors to remain in violent situations longer, and 97 per cent said helping survivors find housing had become more difficult (Women’s Shelters Canada, 2024, pp. 1-3).

This report first explains why waiting matters, then presents the Cost of Waiting Analytical Lens (CWAL) framework and process and applies it to shelter and housing. Implementation worksheets are presented in Appendix A.

Part 1: Understanding the cost of waiting

1.1 Why waiting matters

Needs do not remain static while people wait. Poor health may persist or deteriorate; living expenses continue; unsafe housing or exposure to violence may continue; and employment or education may be disrupted. Applying, following up and appealing can require forms, phone calls, travel and appointments. Families and community organizations often absorb the care and navigation work created by service shortfalls. Being “on a list” therefore does not pause the underlying need or protect a person from lost income, worsening health, violence, housing instability or additional unpaid care.

Failing to measure these consequences creates four policy risks. First, a program may be labelled successful because it meets processing or service-volume targets even when people remain unsafe, unwell or unable to obtain the intended support. Second, costs shifted to individuals, families, employers, community organizations and emergency systems can make an under-capacity program appear less expensive than it is. Third, aggregate results can conceal unequal waits and unequal access to alternatives. Fourth, incomplete evidence can lead governments to underinvest or design policies that do not adequately meet need. Better evidence does not guarantee action: governments may avoid measuring politically damaging outcomes or may decide that preventing these harms is not a priority. Neglect can itself be a policy choice.

1.2 What conventional measures miss

Wait times measure elapsed time, backlogs count unresolved cases, and service standards report whether an administrative commitment was met. These indicators help assess timeliness and access, but they do not show what happened during the period before service was delivered, whether the service achieved its stated goal, or whether meeting the standard still allowed preventable harm to persist.

Results frameworks across governments distinguish program outputs from outcomes, while health-system frameworks also consider access, quality, equity and population outcomes. In practice, however, reporting is often built around the administrative data that funded service providers are required and able to collect. Outputs—such as services delivered, people served and files completed—are easier to count than unsuccessful attempts to obtain help, unpaid care, informal coping, deterioration or costs transferred beyond the program. Administrative systems are primarily designed to account for delivery and funding; they are rarely designed to answer the broader accountability questions raised by the cost of waiting (Treasury Board of Canada Secretariat, 2016; CIHI, 2013).

When the effects of waiting are not measured, crucial information is rendered invisible: people’s time is treated as free, unpaid care and administrative work disappear from the account, and pressure shifted to families, communities or other public systems is mistaken for savings. This weakens accountability for governments and funders, obscures unmet demand and spillover pressures for service providers, and makes preventable harms harder for communities and advocates to demonstrate. For people waiting, it excludes their work, risk and expertise from the official account of performance.

1.3 How waiting shifts work and costs

Administrative burden research describes the learning, compliance, and psychological costs of people’s interactions with the state. Learning costs include discovering a program and determining eligibility. Compliance costs include forms, documentation, appointments and repeated proof. Psychological costs include stress, stigma, loss of autonomy and frustration (Moynihan, Herd, & Harvey, 2015).

These burdens are distributed unequally. The time, care and administrative work created by delayed services fall onto a labour market and household economy in which caregiving is already highly gendered.

Care is essential to economic and social well-being, yet much of it remains invisible, unpaid or undervalued. Statistics Canada reports that women—often migrant and racialized women—perform most paid and unpaid care work, and that unpaid caregiving is associated with opportunity costs and negative well-being outcomes (Wray et al., 2023, pp. 3-4).

In 2022, 42 per cent of Canadians aged 15 or older provided unpaid care to children or care-dependent adults (sandwich caregivers). Women were more likely than men to be sandwich caregivers, and women caregivers were more likely to report negative effects on well-being. Two-thirds of non-retired sandwich caregivers reported employment or job-seeking impacts (Wray, 2024, pp. 3-4). These data establish the unequal baseline onto which service delay is imposed. When public provision is unavailable, care and navigation duties shift among the state, market, community and household—and, within households, disproportionately to women. Each case analysis must then seek direct evidence of the amount and effect of that shift.

1.4 Four guiding principles

Together, the measurement gap, administrative burden and unequal division of care point to four principles. They guide the CWAL stages in Part 2 and the shelter-to-housing application in Part 3.

1.5 The CWAL measurement framework

CWAL is not only a process for examining a wait; it is also a measurement framework for capturing what happens during the delay. The model below organizes waiting impacts into six connected dimensions. These dimensions make visible consequences that may be experienced by individuals and families, transferred to communities and employers, or reappear as pressure elsewhere in the public system.

Gender and equity are not separate impact dimensions. They are distributional questions applied across all six dimensions: who experiences each impact, who absorbs the associated work and cost, and who has the least capacity to withstand the delay?

Part 2: The cost of waiting analytical lens

CWAL combines the six-dimension measurement framework introduced in Part 1 with the four-stage evaluation and advocacy process set out below. It can be applied to a program, benefit, service, referral pathway, decision, wait-list or system backlog. The stages identify the waiting context, measure consequences across the six dimensions, examine their gendered and unequal distribution, and translate evidence gaps into policy and accountability responses.

Stage 1: Identify the waiting context

Begin by defining the service pathway and the boundaries of the wait. This stage establishes who is waiting, when waiting begins and ends, what produces the delay and who may be absent from the formal queue.

Stage 2: Apply the CWAL dimensions of hidden cost

Apply the six-dimension framework to determine what changes while people wait. The dimensions provide a consistent structure for gathering evidence across cases; the questions and indicators below translate the model into an assessment tool.

Stage 3: Apply the gender and equity lens

• Gender is not a seventh result. It is a distributional inquiry used across all dimensions. Examine how pre-existing disparities impact the capacity to absorb a delay and, if feasible, dissect the data.
• Who incurs each cost?
• Who performs additional care and administrative work?
• Who can purchase a private alternative, take unpaid leave or travel?
• Who faces compounded barriers because of disability, race, Indigeneity, immigration status, gender identity, income, family status or geography?
• Whose waiting is hidden because they were turned away, deterred, informally housed or never counted?

Stage 4: Identify measurement and policy gaps

Compare the organization’s official performance framework, intended outcomes, and service-improvement processes with evidence from administrative data, surveys, research, community organizations, and lived experience. Record which consequences are measured, which are known but unmeasured, which require new data, and how the organization is accountable to service users. Then identify the capacity, program-design or systems change required to make gendered burdens visible and actionable.

Part 3: Applying the CWAL lens: shelter and housing

Waiting for safe and affordable housing: Women and children moving through VAW and GBV shelters

A crucial choke point in the housing pathway

The safety of individuals fleeing violence depends on access to secure, affordable housing. The pathway to stable housing includes emergency violence against women (VAW) or gender-based violence (GBV) shelter, transitional or second-stage housing, and safe permanent housing. First-stage shelters generally provide accommodation for days, weeks or a few months; second-stage housing may provide longer-term accommodation for several months to two years. All orders of government participate through shelter operations, social assistance, health and justice services, housing programs and capital funding, but responsibilities and funding streams are fragmented (House of Commons, 2019, p. 14; ACTO, 2025, pp. 1-4).

The most recent national shelter survey provides the primary evidence for current pressures. Shelter Voices 2024 received responses from 216 VAW shelter organizations representing 381 emergency, second-stage, and mixed shelters across all provinces and territories. Of respondents, 99.5 per cent said their community faced a housing crisis; 97 per cent said helping survivors find housing had become harder; 94 per cent of emergency shelters and 83 per cent of second-stage providers reported longer stays. Only three per cent of organizations with a length-of-stay policy consistently met it (Women’s Shelters Canada, 2024, pp. 1-2, 6).

The wait is produced at multiple points. There may be no emergency bed, insufficient transitional-housing capacity, or no affordable permanent unit. Financial barriers, complex benefit processes, priority-list eligibility and housing-market discrimination can further restrict movement (House of Commons, 2019, pp. 47-50).

Policy context: an underfunded continuum of shelter and housing

The present shortage must be understood in historical context. During the COVID-19 pandemic, the federal government provided emergency shelter funding as violence and operational pressures increased and later introduced the National Action Plan to End Gender-Based Violence. At the same time, rising construction and staffing costs, low vacancy rates and the affordability crisis made it harder for survivors to leave shelters for permanent housing. Temporary emergency support did not establish a stable funding base for the entire continuum, particularly for second-stage housing and ongoing operations (Women’s Shelters Canada, 2024, pp. 1-6; House of Commons FEWO, 2026a-e).

Capacity is also a workforce issue. ESVA Canada estimates that roughly 30,000 people work across GBV prevention, response and survivor support. Its 2026 strategy describes chronic underfunding, project-based contracts, funding that does not keep pace with inflation, low compensation, burnout and turnover. Funding models commonly prioritize visible program outputs while excluding core operational and workforce costs. The result can be a cycle in which organizations operate at or beyond capacity, vacancies remain unfilled, service availability contracts and existing staff absorb unmet demand (ESVA Canada, 2026a, pp. 6, 24-33, 41-44).

Transitional housing is the bridge between emergency shelter and stable housing. It typically combines accommodation for three months to two years with counselling, child care, mental health care, case management, employment and housing search support. Recent Ontario research found that a longer timeline, supportive services, and a peer community helped survivors recover and plan without the pressure of an immediate exit; lived-experience participants associated transitional housing with improved well-being and housing stability (Advocacy Centre for Tenants Ontario [ACTO], 2025, pp. 1-3).

Availability remains limited. ACTO reports that more than 268,000 Ontario households were on social housing wait lists in 2025, with average wait times exceeding five years. Although the share of Ontario service managers reporting transitional housing supports rose from 64 per cent in 2021 to 79 per cent in 2024, provision varies locally and remains underfunded. Centralized wait-list data exist in some municipalities or service-manager areas, but there is no consistent national measure of the full shelter-to-housing wait. Survivors may remain in transitional units beyond the intended period because permanent housing is unaffordable, limiting access for the next person in need (ACTO, 2025, pp. 3-4).

The Women and Children’s Shelter and Transitional Housing Initiative provides another indication of the scale of unmet need. Introduced during the COVID-19 pandemic, the $250 million federal initiative supported construction, renovation and repair, as well as top-up operating costs. Women’s Shelters Canada reports that shelters submitted more than $1 billion in requests—four times the available funding. The initiative’s heavy oversubscription demonstrates demand for transitional housing that existing funding could not meet, and Women’s Shelters Canada argues that the program should become a permanent component of federal housing policy (Women’s Shelters Canada, 2025, pp. 1, 4-5).

The need remains urgent as the original National Housing Strategy approaches the end of its funding lifecycle and attention turns to a successor framework, often described by advocates as “Housing Strategy 2.0.” The Canadian Housing and Renewal Association calls for coordination across governments, an integrated housing system, more non-market community housing, and operating support for wrap-around services (Sullivan, 2026). For the GBV sector, the immediate question is whether dedicated, predictable funding for shelter and transitional housing will be embedded in the successor strategy rather than forced to compete within broad housing and homelessness envelopes.

Applying the six dimensions to women and children fleeing violence

The following table illustrates how the six CWAL dimensions can expand the understanding of the situation of women and children fleeing violence. Drawing on selected shelter, housing, parliamentary and economic sources, it identifies consequences associated with waiting and shows where additional measurement would strengthen the evidence. It is an illustration of CWAL’s contribution, not an exhaustive review or a judgement of the overall quality of the studies cited.

Gender and equity distribution

The impacts of housing delays are disproportionately experienced by survivors of gender-based violence. The House of Commons Standing Committee on the Status of Women’s 2019 report, Surviving Abuse and Building Resilience, identifies barriers affecting Indigenous women, women with disabilities, immigrant and refugee women, trafficking survivors, women with mental-health or substance-use needs, transgender women and non-binary people (House of Commons FEWO, 2019, pp. 34-37).

Recent Inuit-specific evidence shows both progress and a persistent access gap. Pauktuutit told the House of Commons Standing Committee on the Status of Women (FEWO) that, as of 2025, 12 Inuit-led shelter or transitional-housing projects had been approved, including an emergency shelter and transition home in Puvirnituq, Nunavik. Yet approximately 59 per cent of Inuit communities still had no emergency shelter. Pauktuutit also reported that 52.9 per cent of Inuit in Inuit Nunangat lived in overcrowded housing and 32.7 per cent lived in homes requiring major repairs. New construction matters, but it does not, by itself, eliminate the wait or the risk of leaving one’s community and support networks. Continuing gaps include stable multi-year operating funding, northern-sensitive affordability measures and burdensome short-term funding processes (House of Commons FEWO, 2026b, pp. 3-4).

Broader housing data show that housing insecurity affects some groups more than others. According to CMHC, 19 per cent of female-led lone-parent households were in core housing need, compared with 13 per cent of male-led lone-parent households and 12.8 per cent of female-led households overall. Rates were also higher among households led by recent refugees, racialized people, and people with disabilities (CMHC, n.d., pp. 3-5). Although these data do not directly measure shelter-to-housing wait-list outcomes, they help identify groups that may face greater barriers to adequate housing.

The feedback loop

The lack of affordable housing affects both the survivor already in shelter and the wider service system. When a survivor cannot move into permanent housing, the temporary bed remains occupied and the next person seeking safety may wait, be turned away or use an unsafe alternative. The 2019 report of the House of Commons Standing Committee on the Status of Women, Surviving Abuse and Building Resilience, links affordable-housing shortages to overcrowded shelters and longer waits for shelter spaces (pp. 49–50). Delay, therefore, produces a system feedback loop:

What conventional shelter and housing measures track—and what they leave invisible

Selected shelter and housing sources demonstrate that conventional indicators capture important organizational activity but not the full pathway or the consequences experienced between stages. The table contrasts commonly reported measures with effects that may remain outside the official record.

The main limitation of shelter and housing evaluations is not that measures such as service use, occupancy, length of stay and housing placements are unimportant. The problem is that these measures are often limited to what happens within an organization. For example, a shelter may report many survivors served and high occupancy without capturing how many people discontinued attempts to obtain admission, how long they remained at risk, whether referrals produced placements, or what happened when permanent housing remained unavailable. Similarly, a housing program may report units constructed without assessing whether survivors can access, afford and sustain safe occupancy of those units.

What selected GBV program evaluations track—and what they leave unmeasured

The selected federal evaluations and progress reports below provide a practical test of the measurement problem. They generally follow a results chain from resources and funded activities to services, participation and short- or medium-term outcomes. That is a valid approach, but it is centred on funded initiatives and people who successfully access them. It does not routinely monitor people who cannot enroll, move repeatedly between systems, stop seeking help, wait between referrals, or experience harm before service begins. This is a focused review of the submitted sources, not an exhaustive survey of all GBV evaluations.

The National Action Plan’s 2024-25 report improves the distinction between outputs and short- and medium-term results and commits to a formal evaluation in 2026-27. Nevertheless, public metrics continue to emphasize resources delivered, partnerships, support availability, awareness and organizational capacity. Although “reliable and timely access” is a stated objective, the published results do not yet report a national indicator for elapsed time, unsuccessful requests or consequences during delayed access (WAGE, 2026, pp. 1-16).

The limitation is one of scope, not an absence of useful evidence. Current frameworks report services delivered and outcomes described by participants after they receive support. They are less able to capture what happens outside the formal service boundary: before admission, after an unsuccessful referral, during transitions between emergency shelter, transitional housing and permanent housing, or when a survivor exits a short-term program without stable housing. These gaps can conceal waiting, displacement and costs transferred to individuals, households, communities and other public systems.

Current sector survey data reinforce this concern. ESVA Canada’s 2026 labour-force plan finds that standardized output-focused reporting can increase administrative workload while overlooking survivor-centered outcomes, relationship building, prevention and system reform. Fragmented, short-term funding that does not keep pace with costs contributes to job insecurity, turnover and burnout. Staffing instability can then reduce service capacity, prolong waits and disrupt continuity of care (ESVA Canada, 2026a, pp. 24-32, 59-69).

Waiting does not need to be a standard component of every GBV program evaluation. It is most relevant when timely access or movement through a service pathway is necessary to achieve the intended outcome. Governments, funders and system planners should assume responsibility for designing and financing proportionate access, capacity and pathway measurement. A small, standardized core—such as turn-aways and a limited number of key pathway time points—can be drawn from existing operational data where feasible. More detailed qualitative, longitudinal or cross-system evaluation should proceed only with dedicated resources, shared tools, data support and survivor participation. It should not be imposed on shelters through unfunded or duplicative reporting requirements.

Measures to add to GBV shelter and housing evaluation

Existing evaluations can be strengthened by adding a proportionate set of pathway, consequence and system-impact measures. The following options respond to gaps identified in the selected federal evaluations, sector reports and shelter and housing evidence reviewed for this case study. They are not a checklist for every shelter: the responsible government, funder or system planner should select the smallest, useful set, reuse existing data and fund any additional collection, analysis and survivor engagement.

Recommendations, by audience

The following recommendations separate the responsibilities of governments, funders and system planners, GBV employers, and advocates and community organizations. Measurement should support service improvement and public accountability without shifting an unfunded administrative burden onto shelters or reducing time available for survivor support.

For federal, provincial and territorial governments

• Renew the Women and Children’s Shelter and Transitional Housing Initiative as a dedicated, predictable capital-and-operating stream within the successor federal housing strategy.
• Publish a transparent accounting of housing allocations and outcomes for women, girls and gender-diverse people, including the earlier 25 per cent commitment and separate GBV, homelessness and Indigenous shelter envelopes.
• Fund the continuum: emergency beds, second-stage housing, permanent non-market housing, portable benefits, child care and wrap-around supports.

For funders and service-system planners

• Fund a small, standardized core of pathway measures across emergency shelter, transitional housing and permanent housing, beginning with feasible operational data such as turn-aways, broad reasons for unsuccessful access and a limited number of key time points—not only occupancy within one program.
• Provide dedicated evaluation funding, staff time, shared definitions, secure data infrastructure and technical support before requesting information beyond this core; streamline or retire duplicative reporting requirements.
• Lead data linkage and system-level analysis to estimate unmet need and avoidable use or costs in emergency shelter, health, justice and homelessness systems, rather than requiring individual shelters to construct the cross-system picture.

For GBV-sector employers

• Treat stable employment, supervision, relief coverage and worker well-being as service-capacity investments that support continuity and survivor outcomes.
• Use existing human-resources and operational information to monitor vacancies, turnover, sick leave and relief coverage for workforce planning; share only necessary, aggregated measures when funders have resourced and streamlined the request.
• Create psychologically safe ways for workers to identify workload, burnout and service-continuity risks, and use the findings for organizational improvement rather than punitive performance management.
• Work with funders and workers to identify which reporting is useful, feasible and proportionate, including relational, preventive and systems-change work that service-volume measures overlook.

For advocates and community organizations

• Use existing capacity data and survivor-defined evidence to advocate for safety, income, children’s well-being, health and community connection; community organizations should not be expected to create new datasets without resources.
• Identify navigation and child-care burdens through voluntary, trauma-informed methods and existing service knowledge, including the support needed to manage housing, benefits, legal and custody processes.
• Advocate for governments and funders to disaggregate outcomes with privacy safeguards and to address populations absent from mainstream shelter data, while minimizing collection demands on frontline organizations and survivors.

The economic case for timely housing investment

The economic cost of sexual violence demonstrates why evaluation must look beyond program expenditures. Ending Sexual Violence Association of Canada (ESVA Canada) and Ripple Strategy estimate that each annual cohort of sexual-assault victims bears $14.8 billion in medical, productivity, property, safety and intangible costs—an average of $21,211 per victim in 2019 dollars. The model also estimates a $255 million reduction in real GDP from lower household spending and $309.6 million in lost current and future income. Some consequences of waiting may be embedded in elevated ill health, lost income and other victim-borne costs, but the study does not separately identify or estimate the incremental cost of delayed shelter, housing or other services (ESVA Canada & Ripple Strategy, 2026, pp. 6-9).

Investment downstream can produce substantial housing, social and economic benefits while reducing the harms and system pressures created by waiting. A 2026 Greater Toronto and Hamilton Area (GTHA) scenario analysis found the strongest results when renovation was combined with new public-housing development, with a modelled benefit-cost ratio of 2.80 and reductions in downstream health, justice and homelessness pressures. Although the analysis is regional and not GBV-specific, it suggests that the case for timely intervention is greater than a capital-cost comparison alone: adequate public-housing investment can both generate benefits and reduce the consequences borne by people waiting and by other services (Canadian Centre for Economic Analysis, 2026, pp. 5-11).

Conclusion

Wait-time measures allow governments and the public to monitor access, compare performance and identify pressure points of access to public services. But time, alone, is an incomplete account of delay.

The Cost of Waiting Analytical Lens reframes waiting as a period during which harms, stress, work, and costs accumulate, and inequality can deepen. It asks analysts to follow those costs across economic security, participation, care, housing, safety and health; to examine their distribution; and to identify what current performance systems leave invisible.

The shelter-to-housing case demonstrates why this matters. A delay in permanent housing can keep a survivor and her children in temporary shelter, prevent another family from entering, and expose people who are turned away to violence or homelessness. Those consequences extend beyond people seeking care to the larger service system: prolonged stays constrain shelter capacity, workforce instability can lengthen waits, and unmet housing need can increase pressure on health, justice, homelessness and community services. Economic evidence also indicates that violence imposes substantial costs on victims and the economy, while timely public-housing investment can generate benefits and reduce downstream pressures. The lens, therefore, changes the policy question from how long people wait to what the wait does, who bears the consequences and what system response is required.

Limitations of this report

• The shelter-to-housing case is an illustrative application of a transferable tool, not a comprehensive sector evaluation.
• The tool requires testing and refinement with people who have lived experience of waiting and with organizations responsible for service delivery.

Appendix A: Applying the CWAL lens

This appendix converts the Cost of Waiting Analytical Lens into a practical workflow. Use the rapid assessment to scope the issue, the evidence guide to match claims to sources, the matrix to organize findings, and the audience-specific questions to translate evidence into accountability and reform. The worksheets are prompts for inquiry—not a scorecard that ranks community knowledge below administrative data.

A.1 Rapid assessment worksheet

Complete this worksheet at the start of a review. It establishes the service pathway, identifies who is missing from formal queues, and prevents the analysis from treating wait duration as the only outcome.

A.2 Evidence-use guide

CWAL uses multiple evidence sources to answer different questions and to identify what existing systems do not collect. No source type should automatically outrank another. Assess fitness for purpose by considering relevance to the claim, credibility, transparency, population and geographic coverage, timeliness, methods, limitations and whose experience is included or excluded. Administrative data can document formal queues and completed services; lived experience and community evidence can reveal unsuccessful access, coping and harm outside program boundaries. When no source addresses a consequence or population, record that absence as an evidence gap and propose ethical data development rather than treating the gap as proof that no harm exists.

A.3 Minimum evidence matrix

Use one row for each consequence. Record the source, its role and scope, and the status of the claim. Assess evidence in relation to the question rather than assigning a single simplistic source of evidence quality. Consider relevance, methods, credibility, transparency, population coverage, timeliness, corroboration and limitations, and state clearly whether evidence is direct, contextual, modelled, mixed or missing.

A.4 Questions for policy analysts

These questions test whether the official framework measures the intended outcome, learns from people who did not complete the pathway, and accounts for effects beyond the immediate service. Every intervention changes demand, workload and outcomes elsewhere in the system; improvements in one program can reduce pressure downstream, while weak capacity or poorly designed targets can shift costs to emergency departments, shelters, justice services, families and community organizations.

• Is the published wait measured from the person’s first need, first contact, completed application, eligibility decision or queue entry?
• Are rejected, deterred and turned-away people visible?
• Does the measure report only people who completed the pathway?
• Can results be disaggregated without compromising privacy or safety?
• Does faster service for one group create longer waits elsewhere?
• Are households supplying unpaid labour that the system does not record?
• Could meeting the official target still generate serious harm?
• Which other public systems bear costs created by this delay?
• How is the organization accountable to people seeking services, and how do their experiences inform evaluation and improvement?

A.5 Questions for community and advocacy organizations

These prompts support advocacy and co-designed evaluation. They help translate lived experience into policy evidence without requiring people to prove escalating harm to receive services.

• What changes in a person’s life between seeking help and receiving it?
• What expenses, care, travel, paperwork and emotional labour occur?
• What unsafe or unstable alternatives are used?
• Which experiences are missing from administrative data?
• What evidence can be collected ethically without making access harder?
• Which lived-experience indicators would make consequences understandable to decision-makers?
• What changes have service users already recommended, and how has the organization responded?

A.6 Building a “Cost of Waiting” indicator set

Begin with the smallest feasible core that can be drawn from information already collected, then add case-specific measures only when they are necessary and resourced. Every set should connect three elements: how long and where people wait; what happens during the wait; and how those consequences differ across groups.

Indicators should be selected with affected communities and frontline organizations. Collection methods must be trauma-informed, accessible and proportionate. Data gathering should never become another condition of access, another burden imposed on the person waiting or an unfunded reporting requirement for service providers. Governments and funders should finance staff time, shared tools, analysis and data stewardship for any new measures.

A.7 From CWAL finding to policy response

Translate each finding into a response that addresses its cause, mitigates immediate harm and identifies who is responsible for implementation. Where delay affects multiple programs, include cross-system coordination and accountability.

A.8 Reporting template

• Use this structure to report the analysis clearly and connect evidence to action:
• The wait: define the pathway, population, start and end points, duration and cause.
• The consequences: synthesize administrative, survey, qualitative, community and lived-experience evidence across the six dimensions.
• The distribution: show who bears the consequences and which groups are missing.
• The measurement gap: compare official indicators and accountability processes with lived consequences.
• The response: identify immediate mitigation, system reform and evidence development.
• The limitations: state the scope, assumptions, uncertainty, dated evidence and unavailable data.

Acknowledgements

The author gratefully acknowledges Katherine Scott for her guidance, substantive feedback and support throughout the development of the Cost of Waiting Analytical Lens. Special thanks are also extended to Trish Hennessy for her thoughtful editorial review and to Robyn Hoogendam of Women’s Shelters Canada for her valuable sector-based feedback on evaluation capacity, reporting burden and the practical realities facing shelters and shelter workers.

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About the author

Nathania Ebegbare

Nathania Ebegbare, Registered Social Service Worker (RSSW), is a Master of Public Policy candidate at the University of Toronto’s Munk School of Global Affairs & Public Policy. Her policy and research interests include gender justice, social and health policy, and equitable access to public services. Her experience spans policy analysis, community-based research and frontline social-service work.